抗菌药降阶梯方案对老年重症获得性下呼吸道感染的临床疗效分析

Clinical analysis of de-escalation therapy for elderly patients with severe acquired lower respiratory tract infection

目的观察抗菌药降阶梯方案对老年重症获得性下呼吸道感染的临床疗效。方法选取2016年1月至2018年1月于本院就诊的老年重症获得性下呼吸道感染患者62例为研究对象,按照完全随机的方式分将其为观察组(31例)和对照组(31例),对照组患者进行常规抗感染治疗,观察组患者采用降阶梯方案进行抗感染治疗。比较两组患者的临床疗效、呼吸力学指标及炎性因子水平变化情况。结果观察组患者治疗总有效率显著高于对照组(P<0.05),感染控制时间和入住ICU时间均显著短于对照组(P_均<0.01),死亡率显著低于对照组(P<0.05)。治疗后,观察组患者吸气峰压(peak inspiratory pressure,PIP)、动态顺应性(dynamic compliance,Cdyn)、吸气阻力(airway resistance,Raw)均显著高于对照组(P_均<0.01),血清脑钠肽、C反应蛋白、白介素-6、降钙素原水平均显著低于对照组(P_均<0.01)。结论抗菌药降阶梯方案对老年重症获得性下呼吸道感染患者的疗效较好,可以明显改善患者肺功能,降低炎性因子水平。

Objective To observe the clinical efficacy of de-escalation therapy for elderly patients with severe acquired lower respiratory tract infection. Method From January 2016 to January 2018, 62 elderly patients with severe acquired lower respiratory tract infection were randomly divided into observation group （31 cases） and control group （31 cases）. Control group patients were treated with routine anti-infection therapy. Observation group patients were treated with anti-infection therapy combined with de- escalation fl^erapy, and fiae changes of clinical efficacy, respiratory mechanics index and inflammatory factors levels were compared between the two groups. Result The total effective rate in observation group was significantly higher than that in control group （P 〈 0.05）, the infection control time and ICU hospitalization time in observation group were significantly shorter than those in control group （Pall 〈 0.01 ）, the mortality rate in observation group was significantly lower than that in control group （P 〈 0.05）. After treatment, PIP, Cdyn, Raw in observation group were significantly higher than those in control group （Pall 〈 0.01）, and the levels of BNP, CRP, IL-6 and PCT in the observation group were significantly lower than those in control group （Pall 〈 0.01）. Conclusion The use of de-escalation therapy in elderly patients with severe acquired lower respiratory tract infection can improve the curative effect, improve the pulmonary function and reduce the level of inflammatory factors.